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NPI Code Detail

MEDICARE: MERRIMACK RIVER MEDICAL SERVICES, INC.

MEDICARE: MERRIMACK RIVER MEDICAL SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2163WA0400XAddiction (Substance Use Disorder) Registered Nurse
3164W00000XLicensed Practical Nurse
4207RA0401XAddiction Medicine (Internal Medicine) Physician
5261QM2800XMethadone Clinic
6261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952384299
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERRIMACK RIVER MEDICAL SERVICES, INC.
Provider Business Mailing Address
First Line : 1720 LAKEPOINTE DR
Second Line :
City : LEWISVILLE
State : TX
Zip : 75057-6458
Country : US
Telephone Number : 214-379-3300
Fax Number : 214-853-9018
Provider Business Practice Location Address
First Line : 323 DERRY RD
Second Line :
City : HUDSON
State : NH
Zip : 03051-3020
Country : US
Telephone Number : 603-595-3399
Fax Number : 603-579-2734
Authorized Official
Title or Position : VP, TREASURER
Name : BRUCE JARVIE
Credential :
Telephone Number : 214-379-3300
Provider Enumeration Date : 11/21/2005
Last Update Date : 07/29/2024

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